Abstract
Gastropericardial fistula (GPF) is a rare but serious complication that can develop years after upper gastrointestinal surgeries. We present the third documented case of recurrent GPF in a 77-year-old male with a complex surgical history, including hiatal hernia repair and multiple thoracic procedures. The patient exhibited nonspecific symptoms, including chest pain, vomiting, and signs of sepsis. Diagnosis was confirmed through CT and esophagogastroduodenoscopy. Treatment involved several surgical interventions: creation of a pericardial window, takedown of the GPF, and placement of an omental flap. This case highlights the importance of early diagnosis, prompt and aggressive surgical management, and diligent postoperative care in addressing GPF.